Method for forming a patient specific surgical guide mount

ABSTRACT

A resection guide locator includes a bone engagement portion with surfaces that are complementary to the surface topographies of a bone to be resected during surgery. A housing includes a socket defined by a resilient annular wall that is sized and arranged so to accept a resection guide by press-fit to thereby position and hold the resection guide within the socket. The resection guide is maintained in a predetermined, preferred position while the surfaces are releasably locked in position on the bone. A method is disclosed for forming and using the resection guide locator.

This application is related to, and claims the benefit of U.S.provisional patent application Ser. No. 61/154,845, filed Feb. 24, 2009,and entitled Patient Specific Surgical Guide Mount.

FIELD OF THE INVENTION

The present invention generally relates to surgical guides, and thefixtures used to locate such guides in relation to a patient's bodyduring orthopedic procedures, such as, total knee, hip, or anklereplacement surgery, and methods for designing and using such instrumentlocators.

BACKGROUND OF THE INVENTION

Total joint (knee, hip, and ankle) replacement prostheses are known inthe art. In many instances, a specially designed jig or fixture enablesthe surgeon to make accurate and precise bone resections of the femoralsurface, the tibial surface, or both in order to accept such prostheses.The ultimate goal with any total joint prosthesis is to approximate thefunction of the natural, healthy structures that the prosthesis isreplacing. Should the prosthesis not be properly attached to the femur,tibia, ankle or foot, any misalignment could result in discomfort to thepatient, gate problems, or degradation of the prosthesis.

For example, when attaching a knee prosthesis it is desirable to orientthe prosthesis such that the pivot axis of the knee joint lies within atransverse plane that is generally oriented perpendicular to themechanical axis of the femur. The mechanical axis lies along a linewhich intersects the femoral head and the center of the ankle. In theprior art, the mechanical axis had been determined from an inspection ofa radiograph of the femur to be resected prior to, or even during thesurgery. During the actual operation, the mechanical axis was determinedby computing its valgus angle from the femoral shaft axis. It was thennecessary to manually align any cutting guide and its fixtures withrespect to the femoral shaft axis in order to achieve an optimum cut.

Often such cutting guides included a femoral intramedullary stem whichwas inserted through a pre-drilled passage way formed in theintercondylar notch and upwardly through the femur along the femoralshaft axis. The stem often included a bracket which supports a distalfemur cutting guide. The bracket included a first pin which extendedthrough the cutting guide to act as a pivot axis. A second pin wasattached to the bracket so as to extend through an arcuate slot in thecutting guide. The cutting guide included pairs of opposing slots formedalong its sides which were oriented to be perpendicular to a centralaxis of symmetry of the cutting guide. When the cutting guide waspivoted, such that the central axis of symmetry lay along the mechanicalaxis, so as to form the appropriate angle with the femoral shaft axis,the cutting guide slots were positioned to be perpendicular to themechanical axis. The cutting guide was then locked into thepredetermined angle with the femoral shaft axis.

In more recent times, computer-aided design techniques have been coupledwith advances in imaging technology to improve joint replacementprostheses and methods. For example, in U.S. Pat. No. 5,735,277, aprocess of producing an endoprosthesis for use in joint replacement isdisclosed in which a reference image for determining contour differenceson a femur and a tibia, are obtained by comparing a correctedpreoperative image of a damaged knee joint with a postoperative image.This technique is then used as the basis for preparing correspondingfemoral and tibial components of an endoprosthesis.

In U.S. Pat. No. 6,944,518, a method for making a joint prosthesis isprovided in which computed tomography, commonly known as a CAT scan (CT)data from a patient's joint is used to design a prosthesis. The CT datais downloaded into a computer aided design software in order to designat least an attachment part, and possibly a functional part, of theprosthesis. The attachment part can be used to attach or otherwiseassociate the functional part to the patient's bone.

In U.S. Pat. No. 5,370,692, a method for producing prosthetic boneimplants in which imaging technology is used to define hard tissuecharacteristics (size, shape, porosity, etc.) before a trauma occurs(“pre-trauma” file) by archival use of available imaging techniques(computed tomography, magnetic resonance imaging, or the like). Loss ofhard tissue is determined by imaging in the locale of the affectedtissue after the injury (“post-trauma” file). The physical properties ofthe customized prosthetic device are specified by comparison of thepre-trauma and post-trauma files to produce a solid model “design” file.This specification may also involve secondary manipulation of the filesto assist in surgical implantation and to compensate for anticipatedhealing process. The design file is mathematically processed to producea “sliced file” that is then used to direct a manufacturing system toconstruct a precise replica of the design file in a biocompatiblematerial to produce the implant.

In U.S. Pat. No. 5,798,924, a method for producing endoprosthesis wherea data block of a three-dimensional actual model of existing bonestructure of a patient is acquired using CT scanning. In a computer, theactual model is subtracted from the data block of an existing or CTscan-generated three-dimensional reference model. Then from thedifference, a computer-internal model for the endoprosthesis is formed.The data blocks of the actual model and reference model are convertedinto the data of a CAD free-form surface geometry.

None of the forgoing methods or devices have adequately providedsurgeons with a way to generate patient specific prostheses, surgicalinstruments, guides, and fixtures, nor have they aided in reducing thenumber or complexity of the fixtures used to locate resection guides inrelation to the patient's body during orthopedic procedures, such as,total knee, hip, or ankle replacement surgery.

SUMMARY OF THE INVENTION

A method for forming a resection guide locator is provided that includesgenerating an anatomically accurate image of a bone, including detailsregarding its surface topographies. A femoral head, a distal femur, adistal tibia and a proximal tibia are each identified, and fivemillimeter thick slices are obtained, at three millimeter spacings.Sagittal slices may also be used in connection with the invention at 2millimeter intervals and essentially zero millimeter spacing. A 2D T1FSE (T1 weighted fast spin echo) imaging sequence is obtained and thenanatomically accurate image is converted to a digital model. A digitalrepresentation of a resection guide locator is added to the digitalmodel so as to form a composite digital model. Advantageously, one ofthe surface topographies is mapped complementarily onto a boneengagement portion of the resection guide locator, which is thenmanufactured based upon the composite digital model so that amanufactured resection guide locator is formed including thecomplementary surface topography on a bone engagement portion, and witha receptacle pocket sized to receive a resection guide with a press-fit.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features and advantages of the present invention will bemore fully disclosed in, or rendered obvious by, the following detaileddescription of the preferred embodiment of the invention, which is to beconsidered together with the accompanying drawings wherein like numbersrefer to like parts and further wherein:

FIG. 1 is a perspective view of femoral and tibial resection guidesmounted within resection guide locators that have been formed inaccordance with the present invention and located upon portions of afemur and a tibia, respectively;

FIG. 2 is a schematic representation of a scanned image of a human kneejoint;

FIG. 3 is a schematic representation of the scanned image of the humanknee joint shown in FIG. 2, after conversion to a computer model inaccordance with the present invention;

FIG. 4 is a schematic representation similar to FIG. 7;

FIG. 5 is a schematic representation, similar to FIG. 3, showingproposed resection lines and local coordinates superpositioned upon thecomputer model of FIG. 3, in accordance with the present invention;

FIG. 6 is a schematic representation similar to FIGS. 4 and 5, butshowing a femoral and a tibial resection guide locator representedwithin the computer model of FIG. 3 in accordance with the presentinvention;

FIG. 7 is a schematic representation similar to FIGS. 4, 5, and 6,showing a digital representation of the femoral and tibial prostheses(in cross section) superimposed within the model in accordance with thepresent invention;

FIG. 8 is a perspective view of a femoral resection guide locator formedin accordance with the present invention;

FIG. 9 is a rear perspective view of the femoral resection guide locatorshown in FIG. 8;

FIG. 10 is an elevational view of the front side of the femoralresection guide locator shown in FIG. 9;

FIG. 11 is an elevational view of the bottom of the femoral resectionguide locator shown in FIGS. 8, 9 and 10;

FIG. 12 is a perspective view of a tibial resection guide locator formedin accordance with the present invention;

FIG. 13 is a perspective bottom view of the tibial resection guidelocator shown in FIG. 12;

FIG. 14 is a top view of the tibial resection guide locator shown inFIG. 13;

FIG. 15 is a rear elevational view of the tibial resection guide locatorshown in FIG. 14;

FIG. 16 is a perspective view of a typical tibial resection guide;

FIG. 17 is a front elevational view of the tibial resection guide shownin FIG. 16;

FIG. 18 is a side perspective view of the tibial resection guide shownin FIG. 17;

FIG. 19 is a perspective view of a femoral resection guide mountedwithin a femoral resection guide locator positioned upon the condyles ofa femur; and

FIG. 20 is a perspective view of a tibial resection guide mounted withina tibial resection guide locator positioned upon the articular surfacesof a tibia.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

This description of preferred embodiments is intended to be read inconnection with the accompanying drawings, which are to be consideredpart of the entire written description of this invention. The drawingfigures are not necessarily to scale and certain features of theinvention may be shown exaggerated in scale or in somewhat schematicform in the interest of clarity and conciseness. In the description,relative terms such as “horizontal,” “vertical,” “up,” “down,” “top” and“bottom” as well as derivatives thereof (e.g., “horizontally,”“downwardly,” “upwardly,” etc.) should be construed to refer to theorientation as then described or as shown in the drawing figure underdiscussion. These relative terms are for convenience of description andnormally are not intended to require a particular orientation. Termsincluding “inwardly” versus “outwardly,” “longitudinal” versus “lateral”and the like are to be interpreted relative to one another or relativeto an axis of elongation, or an axis or center of rotation, asappropriate. Terms concerning attachments, coupling and the like, suchas “connected” and “interconnected,” refer to a relationship whereinstructures are secured or attached to one another either directly orindirectly through intervening structures, as well as both movable orrigid attachments or relationships, unless expressly describedotherwise. When only a single machine is illustrated, the term “machine”shall also be taken to include any collection of machines thatindividually or jointly execute a set (or multiple sets) of instructionsto perform any one or more of the methodologies discussed herein. Theterm “operatively connected” is such an attachment, coupling orconnection that allows the pertinent structures to operate as intendedby virtue of that relationship. In the claims, means-plus-functionclauses, if used, are intended to cover the structures described,suggested, or rendered obvious by the written description or drawingsfor performing the recited function, including not only structuralequivalents but also equivalent structures.

The present invention provides custom manufactured surgical instruments,guides, and fixtures that are based upon a patient's anatomy asdetermined by a computer tomography scanner (CT), magnetic resonanceimaging machine (MRI), or the like medical imaging technology. Forexample, a CT or MRI scanned image 1 or series of images may be taken ofa patient's knee 1, including portions of the limb from the pelvis orthe foot (FIGS. 2 and 3). In the case of a total knee replacement, theCT or MRI scanned image data is then converted from, e.g., a DICOM imageformat, to a solid computer model 3 of the lower limb often includingthe pelvis, femur, patella, tibia, or foot to determine implantalignment, type and sizing using specialized modeling methods that areoften embodied in computer software. Computer generated solid models 3that are derived from CT or MRI scan image data 1 will often includeprecise and accurate information regarding the surface contourssurrounding the structures that have been imaged, e.g., the surfacetopography of the bones or contour of fascia that have been imaged.

The methods disclosed in U.S. Pat. No. 5,768,134, issued to Swaelens etal., and incorporated herein by reference, have been found to yieldadequate conversions of CT or MRI scanned image data 1 to solid computermodel 3 usable with the present invention. In some embodiments, imagesare made of a lower limb, i.e., the pelvis, femur, patella, tibia,and/or foot of a patient using a CT or MRI machine, or other digitalimage capturing and processing unit (FIGS. 2 and 3). This scanninggenerates a scanned image of the diseased knee or ankle joint, includingadjoining portions of the femur 5 and tibia 6. The image data 1 is firstprocessed in a processing unit, after which a model is generated usingthe processed digitized image data.

With one embodiment of the invention scanned images of a diseased kneeor ankle joint, including adjoining portions of the femur 5 and tibia 6,were generated using a Hitachi 0.3T Airis Elite open MRI. The Hitachidevice comprises an asymmetric two-post open architecture, and providesa 0.3T magnetic field strength in a vertical orientation with highhomogeneity. For example, scanned images of a diseased knee jointsuitable for use in connection with the present invention incorporatedsagittal slices of the knee using the patient's patella and tibialtubercle as anatomic landmarks. Two millimeter thickness slices, at zeromillimeter slice spacing were gathered with the scan boundaries definingan approximate field of view of twelve centimeters proximal and ninecentimeters distal of the joint line or the extent of the knee coil. Astandard multiple array extremity coil was utilized with imaging set forbright cartilage and dark bone with crisp boundaries. The patient wasplaced with the leg to be scanned in the middle of the coil. It will beunderstood that in bilateral cases each leg would be scanned separately.

In addition to the forgoing parameters, when generating scanned imagesof a patient's knee for use in connection with the present invention, itis often preferable to acquire a FATSEP 3D RSSG imaging sequence withthe parameters listed in the Table 1 below. For preferred results, veryclear boundaries should be determined between the cartilage andsurrounding soft tissues, and the cartilage and bone. The cartilage willoften present a bright signal and the bone a dark signal, allowing clearcontrast between the two materials.

Scanned images (axial slices) of femur 5 and tibia 6 associated with adiseased knee may also be generated utilizing the rapid body coil of theHitachi 0.3T Airis Elite open MRI. Anatomic landmarks found to be usefulfor these scans included the femoral head and distal femur as well asthe distal tibia and proximal tibia. Five millimeter thick slices, atthree millimeter spacing provided preferred results with the presentinvention. Preferred scan boundaries included the proximal femoral headthrough distal femur and the most proximal tibial point through mostdistal tibial point, e.g., the ankle joint. The patient may be placedwith leg to be scanned in the middle of the coil, it again beingunderstood that in bilateral cases each leg would be scanned separately.

The field of view available from the rapid body coil may not alwayscover the entire femur or tibia within one scan. In such instances, thefemur or tibia may be scanned in two separate regions. Between the twoscans the patient will have to move in order to reposition the coil tocover the most proximal or distal regions of interest. It is importantin such instances to provide as much overlap as possible between the twoscans. The patient's leg should be placed in the middle of the coil toensure the largest field of view possible without distortion. Thecorners of the images at the field of view limits of the coil aresusceptible distortion. The patient's legs should be scanned separately,as bilateral scans place the proximal and distal ends of the knee jointregion within the field of view limitation and within areas of possibledistortion. Additionally, a 2D T1 FSE (T1 weighted fast spin echo)imaging sequence may be acquired with the parameters listed in theTable 1. It should be noted that the boundaries of the bone, from theball of the femoral head down to the distal condyles, should be clearfor processing.

TABLE 1 Hitachi 0.3T Airis Elite Sequence Overview Hip-Knee KneeAnkle-Tibia Coil Rapid Body Multiple Array Rapid Body Coil ExtremityCoil Coil Study (Pulse 2D T1 FSE FATSEP 3D RSSG 2D T1 FSE Sequence) TR(ms) 2700   61  2700   TE (ms) 10   28.5 10  Plane Axial Sagittal AxialSlice Thickness (mm) 5 2 5 Slice Spacing (mm) 3 0 3 NEX 2 1 2 Flip Angle90  90  90  Matrix 256*256 512*512 256*256 Acquisition Time 5:46 15:375:46 (min:sec)

In accordance with the present invention, interactive processing andpreparation of the digitized image data is performed which includes themanipulation and introduction of additional extrinsic digitalinformation 8, such as, predefined reference locations 9 for componentpositioning and alignment 10 so that adjustments to the surgical site,that will require resection during surgery, may be planned and mappedonto computer model 3 (FIGS. 4 and 5). After the interactive processingof the digitized image data, it is possible to go back to original CADdata to obtain a higher resolution digital representation of the patientspecific surgical instrument, prostheses 7 a, 7 b (FIG. 7) guide, orfixture so as to add that digital representation to the patient's imagedata model.

For example, when the system of the present invention is used for kneereplacement surgery, a digital representation of a femoral resectionguide mount 20 may be added to the patient's image data model (FIGS. 1and 6). In the context of a total knee replacement, femoral resectionguide mount 20 may be formed for placement on the exposed condyles of apatient's femur to assure precise and accurate positioning of a femoralresection guide 26 which is used to direct and control bone resection offemur 5 during surgery. Although the femoral resection guide 26 can takevarious forms and configurations, the present invention will bedescribed with reference to a distal resection guide currently offeredby applicant Wright Medical Technology, Inc. (Wright Medical Part No.K001-2659). Significantly, femoral resection guide mount 20 providesthis precise and accurate positioning function without the need forother external fixtures or the use of an intramedullary stem insertedthrough the intercondylar notch and upwardly through femur 5 along thefemoral shaft axis. A digital representation of a tibial resection guidemount 22 may also be added to the patient's image data model (FIG. 6).Tibial resection guide mount 22 is similarly formed for placement on theexposed superior articular surface of a patient's tibia 6 to assureprecise and accurate positioning of a tibial resection guide 28 used todirect and control bone resection of the superior articular surface ofthe exposed tibia during surgery.

Referring to FIGS. 8-11, a femoral resection guide mount 20 according toone embodiment of the invention is formed from a resilient polymermaterial of the type that is suitable for use in connection with stereolithography or the like manufacturing equipment. Resection guide mount20 comprises a unitary block including a bifurcated condylar yolk 25 anda guide receptacle 29. Bifurcated yolk 25 includes a pair of spacedapart arms 30, 31 that project outwardly from a base 33. Arm 30 has alower or bone engaging surface 36 and a through-bore 42, and arm 31 hasa lower or bone engaging surface 40 and a through-bore 38. Through thepreviously discussed imaging operations, the bone engaging surfaces 36,40 are configured for complimentary matching with anatomical surfacefeatures of a selected region of the patient's natural bone. For thefermoral resection guide mount 20 embodiment of FIGS. 8-11, the selectedbone region comprises the condyles of the patient's femur.

Guide receptacle 29 includes a pair of wings 44,46 that projectoutwardly, in opposite directions from base 33 and in spaced relation toarms 30,31. Each wing 44, 46 includes a pylon 48 projecting upwardly tosupport guide housing 49 such that an elongate slot 52 is definedbetween base 33 and guide housing 49. Slot 52 is sized and shaped toallow a typical surgical saw, of the type often used for bone resection,to pass through from a correspondingly positioned and sized slot inresection guide 26 without contact, or with only incidental contact withresection guide locator 20. An annular wall 55, having a shape that iscomplementary to the outer profile of femoral resection guide 26,projects outwardly in substantially perpendicular relation to a backwall 61 and thereby defines a recess 58. In some preferred embodiments,recess 58 is sized so as to accept femoral resection guide 26 with a“press-fit”. By press-fit it should be understood that annular wall 55is sufficiently resilient to deflect or compress elastically so as tostore elastic energy when femoral resection guide 26 is pushed intorecess 58. Of course, it will also be understood that femoral resectionguide 26 will have an outer circumferential shape that is complementaryto the circumferential shape of recess 58, but slightly larger in size,for press-fit embodiments. Also, femoral resection guide 26 may beretained within recess 58 by only frictional engagement with annularwall 55 or, in less preferred embodiments, resection guide 26 can simplyslide into recess 58 without operative contact or only incidentalengagement with annular wall 55. First through-bores 62, 64 are definedin back wall 61 in spaced relation to one another, with a secondthrough-bore 67,69 being associated with each first through-bore 62,64.In the embodiment shown in FIGS. 8-11, the first through-bores 62, 64are large square or rectangular openings, a configuration that easesmanufacture, reduces material use, and provides sufficient space fordriving pins, wires, screws or other appropriate fasteners through aplurality of adjacent bores provided on the femoral resection guide 26.A groove 70 is defined in the outer surface of base 33 and centrallylocated with respect to recess 58.

Referring to FIGS. 12-18, a tibial resection guide mount 22 according toone embodiment of the invention is formed from a resilient polymermaterial of the type that is suitable for use in connection with stereolithography, selective laser sintering, or the like manufacturingequipment, e.g., a polyamide powder repaid prototype material issuitable for use in connection with selective laser sintering. Resectionguide mount 22 comprises a unitary block including a bifurcated yolk 75and a guide receptacle 79. Bifurcated yolk 75 includes a pair of spacedapart arms 80, 81 that project outwardly from a base 83. Arm 80 has alower surface 86 and arm 81 has a lower surface 90.

Guide receptacle 79 includes a pair of wings 84, 86 that projectoutwardly, in opposite directions from base 83 and in spaced relation toarms 80,81. Each wing 84,86 includes a pylon 88 projecting upwardly tosupport guide housing 89 such that an elongate slot 94 is definedbetween base 83 and guide housing 89. Slot 94 is sized and shaped toallow a typical surgical saw, of the type often used for bone resection,to pass through from a correspondingly positioned and sized slot inresection guide 28 without contact, or with only incidental contact withresection guide locator 22. An annular wall 95, having a shape that iscomplementary to the outer profile of tibial resection guide 28,projects outwardly in substantially perpendicular relation to a backwall 101 and thereby defines a recess 108. Recess 108 is sized so as toaccept tibial resection guide 28 with a press-fit. First through-bores112, 114 are defined in back wall 101 in spaced relation to one another,with a second through-bore 117, 119 being associated with each firstthrough-bore 112, 114.

Returning to the digital image models 3 previously disclosed, andconsidering a generalized digital model of resection guide mount 20added to the patient's femur image data, the anatomic surface featuresof the patient's femur, e.g., the condylar surface topography, may becomplementarily mapped onto each of lower surface 36 and lower surface40 of arms 30, 31. It will be understood that complementary mapping ofthe digital images results in localized prominences on the surface of abone, e.g., a condyle or articular surface, becoming localizedconcavities on lower surface 36 or lower surface 40, while localizedconcavities on the surface of a bone become localized prominences onlower surface 36 or lower surface 40. In this way, each of lower surface36 and lower surface 40 is redefined with a complementary, substantiallymirror image of the anatomic surface features of a selected region ofthe patient's femur. As a consequence of this complementary bone surfacemapping, resection guide mount 20 releasably “locks” on to thecomplementary topography of the corresponding portion of the patient'snatural femur, e.g., the condylar surfaces, without the need for otherexternal or internal guidance fixtures. A substantially identicalmapping is carried out in connection with the design of a patientspecific tibial resection guide mount 22.

A visual presentation of the virtual alignment results between thepatient's femur and resection guide mount 20 is created and forwarded tothe surgeon to obtain approval of the results prior to manufacturing(FIGS. 1, 19, 20). Upon receipt of the surgeon's approval, resectionguide mount 20, and in appropriate instances resection guide mount 22,is manufactured and returned to the surgeon for use in the surgery.

During a total knee replacement the present invention is used in thefollowing manner. The surgeon first orients resection guide mount 20 onfemur 5 until lower surfaces 36, 40 of resection guide mount 20 “lock”to the topography of the exposed surface 4 of femur 5. With resectionguide mount 20 locked onto the patient's femur, a surgeon press-fits anappropriately configured Distal Resection Guide 26 (e.g. Wright MedicalTechnology, Inc. Part No. K001-2659) in recess 58 of resection guidemount 20. As indicated in FIGS. 19-20, this results in the resectionguide mount 20, and particularly the guide receptacle portion 29 of theresection guide mount 20, being sandwiched between the resection guide26 and the patient's bone. Pins are driven into through-bores of theresection guide 26, but advantageously the pins do not come into contactwith the portions of resection guide mount 20 that define through-bores62, 64 or 67, 69. These through-bores are often the most proximal onresection guide mount 20. With resection guide mount 20 held securely inplace, a drill bit is advanced into through-bores 38 and 42,through-bores 62, 64 defined in back wall 61, and/or into secondthrough-bores 67,69. It is often preferable for the drill to protrudeabout 15 mm into through-bores 38 and 42 into the femoral bone so thedrill holes will be present after the distal resection. Increased holedepth may be necessary in the event of a larger distal resection tocorrect a flexion contracture. For additional stability, fixation pins(not shown) may be left in through-bores 38 and 42, but must be removedprior to resection. With the resection guide mount 20 thus accuratelypositioned with respect to the selected bone region and the resectionguide 26-guide mount 20 construct appropriately secured to the patient'sbone, the surgeon uses a conventional surgical blade and the resectionslot of the resection guide 26 to resect the patient's bone.

It is to be understood that the present invention is by no means limitedonly to the particular constructions herein disclosed and shown in thedrawings, but also comprises any modifications or equivalents within thescope of the claims.

What is claimed is:
 1. A method comprising the steps of: (A) generatingan anatomically accurate image of a bone of a patient that includessurface topographies by scanning the bone in two scans using an imagingapparatus, each scan being of a separate region of the bone, whereinbetween said two scans the patient will move in order to reposition acoil of the imaging apparatus to cover a most proximal or a most distalregion of interest of the bone; (B) using a computer processor toconvert said anatomically accurate image to a digital model; (C) usingthe computer processor to add a digital representation of a resectionguide locator to said digital model to form a composite digital model;(D) using the computer processor to map one of said surface topologiescomplementarily onto a bone engagement portion of said digitalrepresentation of the resection guide locator to provide a customizeddigital representation of the resection guide locator; and (E)manufacturing the resection guide locator based upon the customizeddigital representation of the resection guide locator such that themanufactured resection guide locator includes a complementary surfacetopology on a bone engagement portion and a receptacle pocket sized toreceive a resection guide with a press-fit, wherein the manufacturedresection guide locator defines an elongate slot within the receptaclepocket, the elongate slot positioned within the receptacle pocket suchthat the elongate slot of the resection guide locator aligns with anelongate slot defined by the resection guide when the resection guide isreceived within the receptacle pocket.
 2. The method of claim 1 furthercomprising setting the coil to at least one of a multiple arrayextremity coil and a rapid body coil in order to scan the bone in twoscans.
 3. The method of claim 1 wherein scanning the bone in two scansincludes applying a pulse sequence to the coil of at least one of aFATSEP 3D RSSG and a 2D T1 FSE.
 4. The method of claim 3 whereinscanning the bone in two scans includes a TR time of at least one of 61milliseconds and 2700 milliseconds; and a TE time of at least one of 10milliseconds and 28.5 milliseconds.
 5. The method of claim 3 whereinscanning the bone into two scans includes using the imaging apparatus toprovide a flip angle of 90°.
 6. The method of claim 3 wherein scanningthe bone in two scans includes using a matrix of at least one of 256 by256 pixels and 512 by 512 pixels.
 7. The method of claim 3 whereinscanning the bone in two scans includes performing at least one of thetwo scans with an acquisition time of at least one of 5:46 (min:sec) and15:37 (min:sec).
 8. A method comprising the steps of: (A) generating ananatomically accurate image of a bone of a patient that includes surfacetopographies by scanning the bone in at least two scans using an imagingapparatus, each scan being of a separate region of the bone and at leastpartially overlapping one another, wherein between said at least twoscans the patient will move in order to reposition a coil of the imagingapparatus to cover a most proximal or a most distal region of interestof the bone; (B) using a computer processor to convert said anatomicallyaccurate image to a digital model; (C) using the computer processor toadd a digital representation of a resection guide locator to saiddigital model to form a composite digital model; (D) using the computerprocessor to map one of said surface topologies complementarily onto abone engagement portion of said digital representation of the resectionguide locator to provide a customized digital representation of theresection guide locator; and (E) manufacturing the resection guidelocator based upon said digital representation of the customized digitalrepresentation of the resection guide locator such that the manufacturedresection guide locator includes a complementary surface topology on abone engagement portion and a receptacle pocket sized to receive aresection guide therein with a press-fit, wherein the manufacturedresection guide locator defines an elongate slot within the receptaclepocket, the elongate slot positioned within the receptacle pocket suchthat the elongate slot of the resection guide locator aligns with anelongate slot defined by the resection guide when the resection guide isreceived within the receptacle pocket.
 9. The method of claim 8 furthercomprising setting the coil to at least one of a multiple arrayextremity coil and a rapid body coil.
 10. The method of claim 8 whereinscanning the bone in the at least two scans includes applying a pulsesequence to the coil of at least one of a FATSEP 3D RSSG and a 2D T1FSE.
 11. The method of claim 10 wherein scanning the bone in at leasttwo scans includes a TR time of at least one of 61 milliseconds and 2700milliseconds; and a TE time of at least one of 10 milliseconds and 28.5milliseconds.
 12. The method of claim 10 wherein scanning the bone intotwo scans includes using the imaging apparatus to provide a flip angleof 90°.
 13. The method of claim 10 wherein scanning the bone in twoscans includes using a matrix of at least one of 256 by 256 pixels and512 by 512 pixels.
 14. The method of claim 10 wherein scanning the bonein the at least two scans includes performing at least one of the twoscans with an acquisition time of at least one of 5:46 (min:sec) and15:37 (min:sec).
 15. The method of claim 8 wherein a scan boundary of atleast one of the at least two scans includes a proximal femoral headthrough a distal femur and a most proximal tibial point through a mostdistal tibial point of a patient's leg.
 16. The method of claim 8further comprising placing a patient's leg in the middle of the coil toensure the largest field of view possible without distortion.
 17. Themethod of claim 1, wherein the manufactured resection guide locatorincludes a first pair of holes within the receptacle pocket that do notintersect with the elongate slot defined by the manufactured resectionguide locator.
 18. The method of claim 17, wherein the first pair ofholes defined by the manufactured resection guide locator align with asecond pair of holes defined by the resection guide when the resectionguide is received within the receptacle pocket.
 19. The method of claim8, wherein the manufactured resection guide locator includes a firstpair of holes within the receptacle pocket that do not intersect withthe elongate slot defined by the manufactured resection guide locator,and wherein the first pair of holes defined by the manufacturedresection guide locator align with a second pair of holes defined by theresection guide when the resection guide is received within thereceptacle pocket.
 20. The method of claim 1, wherein the receptaclepocket is defined by a resilient wall configured to retain the cuttingguide within the receptacle pocket.